Healthcare Provider Details

I. General information

NPI: 1023542925
Provider Name (Legal Business Name): JOHN SCARBOROUGH ACNPC-AG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2017
Last Update Date: 04/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 WHITCHER ST NE STE 160
MARIETTA GA
30060-1160
US

IV. Provider business mailing address

3144 BROOKEVIEW LN NW
KENNESAW GA
30152-2708
US

V. Phone/Fax

Practice location:
  • Phone: 770-422-1372
  • Fax:
Mailing address:
  • Phone: 678-357-7628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberRN220352
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: